THE EFFECTS OF EPIDURAL ANALGESIA ON THE COURSE AND OUTCOME OF LABOR

The potential effects of epidural analgesia on the progress and outcom e of labour have been the subject of lasting controversy. Retrospectiv e reviews indicate that epidurals are associated with longer labours a nd/or an increase in the incidence of instrumental or operative delive ry, Similar results were obtained in non-randomized prospective studie s. None of them established a causal relationship, because without ran domization the selection bias cannot be ruled out. Other factors, such as premature rupture of membranes and maternal socioeconomic status, may affect the outcome of labour. It was also reported that introducti on of the on-demand epidural service did not increase the primary caes arean section rate. The few prospective randomized studies are contrad ictory and not very reliable owing to small patient populations and hi gh cross-over rates. There is, however, unanimity among the authors re garding the superiority of pain relief provided by epidural blocks ove r systemically administered opioids.